Low HDL Symptoms

HDL is considered "good" cholesterol, and levels should be greater than 40 milligrams per deciliter (mg/dL). There are no symptoms associated with low HDL levels, but it does increase your risk for cardiovascular disease. Associated signs include stroke, heart attack, premature coronary artery disease, and peripheral polyneuropathy.

Having low HDL levels increases your risk for complications, such as metabolic syndrome, heart failure, and diabetes.

This article discusses low HDL symptoms and complications. It also covers when to see your healthcare provider.

Frequent Symptoms

The symptoms of low HDL levels aren’t always easy to distinguish.

Some people may not know they have low HDL levels until after a medical emergency, like a heart attack or stroke. Regularly following up with your healthcare provider for routine bloodwork helps monitor for any disease risks, like a low HDL level.

More frequent signs of low HDL levels include:

• Premature coronary artery disease: Diagnosis before 55 years in males or 65 years in females is considered premature. Without an adequate HDL level, there is a higher risk for plaques forming to block arteries.
• Heart attack or stroke: Plaques forming in the blood increase the risk they will dislodge or arteries flowing to the heart and brain will become blocked.
• Peripheral polyneuropathy: This is a common complication of uncontrolled high blood sugar levels in diabetes. Research has found that low HDL levels may increase the risk for peripheral polyneuropathy developing in people without diabetes.

Rare Symptoms

A rare genetic disease called Tangier disease can cause there to be no HDL levels in the blood when the person carries the disease from both of their parents. For someone with the Tangier disease gene from just one of their parents, HDL levels are 50% of normal levels.

Low HDL levels may cause deposits of cholesterol to form throughout the body. They commonly form in the reticuloendothelial system, which removes dead or diseased cells, tissues, and other substances from the body.

The low HDL levels in Tangier disease are associated with the following symptoms:

• Enlarged liver and spleen caused by cholesterol deposits around these organs
• Xanthomata, which are yellowish cholesterol-rich deposits that can appear anywhere in the body, sometimes forming large foam-like bumps visible on the surface of the skin
• Xanthelasma, which are yellowish plaques that form on the inner portion of the eyelid, more often on the upper eyelid
• Arcus corneae, a white, gray, or blue arc that typically begins above the cornea and may form a complete circle around it
• Enlarged tonsils and lymph nodes, caused by deposits: Yellow or white-colored deposits may appear on the surface of the enlarged tonsils.

Low HDL levels may occur in another genetic condition called fish-eye disease. This condition is named for the cloudy appearance it causes on the front surface of the eyes.

Complications

Consistently low HDL levels can worsen the symptoms of other health conditions. It may increase your risk for complications, like:

• Metabolic syndrome: This group of conditions, when they occur together, increases your risk for heart disease, stroke, and diabetes. Abnormal cholesterol levels are one of the conditions, and having low HDL levels can exacerbate the effects of metabolic syndrome.
• Heart failure: Low HDL is associated with a higher risk for developing heart failure.
• Diabetes: Low HDL levels have been associated with higher levels of insulin resistance. Having high insulin resistance makes it more difficult for your body to bring the sugar from your blood into tissues. Insulin resistance causes high blood sugar levels and increases the risk of developing diabetes.

When to See a Healthcare Provider

You most likely won’t experience any symptoms of a low HDL level early on. It’s important to meet with a healthcare provider consistently for routine bloodwork to monitor for silent risk factors for disease.

If your healthcare provider finds that you have abnormal cholesterol levels, they can help you get them into a healthy range. They may recommend medications, called statins, to help lower LDL levels. 

Lifestyle changes to help to increase HDL levels include:

• Eat a healthy diet
• Get regular exercise
• Lose weight
• Quit smoking
• Limit alcohol intake

A referral to a registered dietitian can help you to understand how your diet affects your cholesterol levels and make personalized changes for your needs.

Call 911 or seek immediate medical attention if you are experiencing any of the following symptoms because they may be a sign of a heart attack or stroke:

• Chest discomfort, pressure, or squeezing sensation
• Chest pain, particularly on the left side in males
• Shortness of breath or difficulty breathing
• Weakness on one side of the body
• Slurred speech
• Drooping on one side of the face
• Confusion
• Sweating or a clammy feeling
• Loss of consciousness

Summary

Not all cholesterol is bad for you—both LDL and HDL play important roles in the body. The problem is when LDL levels get too high and HDL levels are too low. HDL is considered the “good” cholesterol because it helps to remove “bad” cholesterol and protect your health.

Having low HDL levels doesn’t often cause symptoms, especially early on. It’s important to meet with a healthcare provider for routine visits and lab work to monitor your risk for chronic diseases, like heart disease and diabetes, that can be prevented through healthy lifestyle changes.